Me: "Excuse me, I'd like to speak to the surgery resident taking care of this patient?"
Nurse: "He's in surgery, so you can't contact him."
Me: "Yeah, but I need to tell him something important about his patient."
Nurse: "Well, you have to wait till the surgery is finished."
Me: "But it's almost 5. Do you know when he'll be done?"
Nurse: "No."
Me: "Is there any way I can leave a message for him?"
Nurse: "No. You have to wait until the surgery is finished."
Me: "But isn't there someone answering his pager?"
Nurse: "Yes, but if you call, they'll just tell you that he's in surgery."
Me: "So what if something happens with one of his patients? Like what if the guy starts having chest pain? Doesn't someone still have responsibility for his patients?"
Nurse: "You can try paging him after the surgery."
(Blows into and taps on pretend microphone in her hand) "Is this thing on?"
ReplyDeleteI thought it was infuriating too until I did my surgery rotation. It's pretty easy to see how taking calls mid-surgery and thinking about other patients while cutting someone up can break some people's concentration. Was your question that urgent? And if the guy starts having chest pain, what do you expect him to do? Leave mid-surgery? Wasn't there anyone else who could solve that problem (in case it happened) during surgery time?
ReplyDeleteMariana: That was my question, who was responsible for his patients? I get that maybe he couldn't leave mid-surgery, but there ARE emergencies that come up with patients, so not having any physician or NP or whatever covering for him is kind of irresponsible. Plus I should have at least been able to leave a message for him.
ReplyDeleteFizzy: Oh, yes, he should definitely have someone covering for him and if you called they should take your message and see if they could do anything about it. If he didn't leave someone in charge, then he is at fault, no question :) But from what I read he left someone, right?
DeleteAnd just a disclaimer: I hate surgery. Really, really hate it. My love is for Internal Medicine, but as I said before, I changed my perspective after my surgery rotation.
I think it's pretty clear from the dialogue above that there *wasn't* a designated person left in charge of his patients.
DeleteWhen you wrote that someone had his pager I thought it was an intern or someone in charge who wasn't particularly cooperative. =P
DeleteI think the problem is that you were talking to the floor nurse, not the circulating nurse taking care of his pages. That, and usually someone is covering floor work, like the intern.
DeleteWell, if there's an emergency of the level of a code, someone scrubs out.
ReplyDeleteIf it's something less, but still important, like precipitous blood pressure drops or chest pain or whatnot, we try to deal with it over the phone. Seriously not fun, though, to have the phone held up to your ear so you can long-distance diagnose and treat someone, while trying to do surgery.
Anything else can and does wait. Oh, the magic of scrub nurses telling people to 'call back later, YES, LATER, no I don't care that you're professor so-and-so, our resident is busy so CALL BACK LATER!"
And yes, I realize this is very very annoying for the other party and apologise for that. I can assure you, though, that it's necessary from our point of view. The one scrub nurse, who tried to get me to talk to everyone who called, got kicked out of the OR by an irate attending who thought my attention was better spent on the patient whose liver I was currently prodding.
"Call back later" is not the easiest thing to do when you have no idea when the surgeon is going to be done. What if when I call back, the surgery is still going on? What if he's in another surgery? Doesn't it make more sense for me to leave a message so he could call me back when he's free instead of me calling and calling until I catch that golden moment when he's available? (The specific message I needed to leave didn't require me to be necessarily called back.)
DeleteConsult request. They get stacked up on a desk we can't miss no matter what and you don't even need to call in the first place. It has to be filled anyway, so a lot of people would save themselves a lot of waiting around for a surgeon, if they used it right away.
DeleteI obviously can't comment on your case, since I don't know why you needed a surgeon or how your hospital is organized, but here, a lot of this same irritation stems from impatience. People decide to call us and expect us to be available all the time, because they don't feel like waiting for someone to pick up the request and go have a look at it. So yes, unless things are right-now-urgent, people are told to call back later. Still leaves them with the choice to stop being impatient, and fill out and send the form.
The situation was that the surgeon had asked for a consult on one of HIS patients, and I had some recommendations for him that needed to be acted on that day so that HIS patient could be ready for surgery. So I just wanted to make sure he got the recommendations. I didn't think it was fair to make me call him all night just to transmit this information.
DeleteAh, see, our consult request works both ways. In that case, you'd be leaving the written recommendation on that form and either the operating surgeon or the on call team would act on it in time.
DeleteYes, but we didn't have that system. So my only option was to either call him repeatedly all night till I got through, or just hope he'd read the recs left in the chart (unlikely). You can see how that was frustrating to me.
DeleteActually, I have to say though, that was the only time someone answered a pager for a surgeon and then refused to take a message.
The surgical services that i've rotated through usually have an intern or med student covering the floor who can triage patient issues while the more senior residents are in the OR. Obviously, this wasn't the case in your example, and I agree that it is irresponsible and bad patient care to not be available for untold amounts of time for patient issues. When I was in ICU, we had patient issues come up all the time while we were in the middle of delicate procedures, and a nurse could always just hold a phone up to your ear -- no big deal.
ReplyDeleteP.S. I do agree that -- while i was on the surgical rotations -- it was lovely to not be bothered unless absolutely necessary. i.e. not having to respond to a dozen calls from the floor wanting me to cosign the dietician's orders, or that mr. so-and-so has questions that need to be answered RIGHT NOW, etc.
DeleteWhen I was a neurosurgical junior resident on the neurotrauma service, we learned to answer the pager at least 15 times per hour no matter WHAT we were doing, and often that was operating. It is possible to keep operating and answer questions about other patients at the same time. Not fun, but part of the job. If you can't manage to do this, you need to find another specialty.
ReplyDeleteCurrently, as a private practitioner, I still answer all calls (via the circulator) during surgery. If I can't manage it over the phone and the situation is critical, I call my partner to help me out. That's happened maybe 3 times in the last 6 years.
I wouldn't feel comfortable at all with having all calls to me blocked during surgery. Somebody could die. I'd rather be aware of what's going on and be able to deal with it. In the last resort, I can scrub out, run stabilize an emergency, then scrub back in. Fizzy, you can call me anytime! :-)
That's weird. If I'm scrubbed in, the circulating nurse answers my pager and tells me what's going on. If it's an emergency, I scrub out if I can, if not, I scrub out as quickly as possible. If it's something like discharge paperwork and hte patient wants to leave and I'll be scrubbed in forever, I ask them to page the resident on call, but usually it's not a problem.
ReplyDeleteYes to this entry! I once paged the whole surgical team, including the junior medical officers, with no answer for half an hour. I ended up chasing them down in the corridors. Literally.
ReplyDeleteYeah, you page them, the unscrubbed person in the room calls you back and you play broken Telephone with them and tell them what's going on. That's what I do.
ReplyDeleteI recently called a fellow family physician about his patient who had transferred care to me. I had not received the medical records and needed some background information. When I called I was told that he was unavailable, would be leaving the office early that day and no, I could not leave a message because "Dr. X does not answer phone messages".
ReplyDeleteWhen I asked how on earth I was supposed to reach him I was told by his oh-so-helpful front desk staff that I would just have to keep calling.
Are you freaking kidding me????